Leverage mechanical alterations during walking at self-selected speed in patients with Parkinson's disease.

Individuals with Parkinson's disease (PD) show poor walking performance compared to healthy adults. Leverage changes may provide insight into this walking abnormality, since they have important effects on both biomechanical and physiological variables. Hence, we investigated the differences in internal and external moment arms at the knee and ankle joints, as well as the effective mechanical advantage during walking at self-selected speed. Furthermore, the effects on walking of a simultaneous cognitive task were analysed. Kinetic (resultant ground reaction force and joint moments), kinematic (movement speed) and mechanical leverage (internal and external moment arms) parameters of 10 mild-to-moderate PD patients and 10 age-matched controls were measured in single and dual task condition. Finally, effective mechanical advantage was calculated as the ratio between internal and external moment arm for each joint. PD patients had a slower walking and showed larger and lower values of knee and ankle joint moments, respectively. No difference in force among groups was recorded. External moment arms were larger (in both joints) for PD, whereas slight changes were observed for internal moment arms. Consequently, effective mechanical advantage values seemed to be lower for PD. Surprisingly, leverage difference among groups was reduced during the dual task condition, resulting in a "more effective" walking strategy for PD. These findings suggest that during single task PD patients have several leverage disadvantages, which could affect the joint assessment. On the contrary, during dual task they reduced these mechanical negative effects by positively obtaining normal values of effective mechanical advantage.

Metabolic and kinematic parameters during walking with poles in Parkinson's disease.

In healthy people, energy expenditure is generally higher during walking with poles (WP) than during conventional walking (W). In persons with Parkinson's disease (PD), walking is slower and may be associated with greater energy consumption, stride-to-stride variability, and difficulty in regulating stride length. The aim of this study was to determine whether treadmill WP at three different speeds could induce changes in gait kinematics and oxygen consumption in PD patients. The study sample was 20 patients with mild-to-moderate PD and 20 age-matched healthy controls. Subjects underwent 5-min W and WP treadmill tests at three different speeds (2.5, 3.5, and 4.5 km/h). Metabolic and gait parameters (ventilation, gas exchange, stride count and length) were recorded. As compared with the healthy controls, higher energy consumption (P < 0.05) (and other metabolic parameters), shorter stride, and reduced cadence (P < 0.05) were observed for the PD patients, independent of the walking technique. All subjects were noted to take longer strides during WP (P < 0.001), especially at the lowest treadmill speed. However, significantly higher energy consumption was observed only for the healthy controls (P < 0.05). No changes in metabolic parameters during WP were recorded; however, a substantial improvement in gait cycle length was noted for the PD patients.